- N Engl J Med 2022; 387:738-747
A 48-year-old woman was evaluated for abdominal pain. CT showed numerous liver lesions and lung cysts and nodules; liver biopsy revealed an eosinophilic inflammatory infiltrate. A diagnosis was made.
- N Engl J Med 2022; 387:641-650
A 25-year-old woman was evaluated for worsening headaches, photophobia, nausea, vomiting, and blurred vision. MRI revealed hydrocephalus and leptomeningeal enhancement. CSF analysis revealed neutrophilic pleocytosis.
- N Engl J Med 2022; 387:547-556
A 31-year-old man was admitted with perianal and penile ulcers, rectal pain, and vesiculopustular rash. He had first noticed itchy white “bumps” around the anus 9 days earlier. A diagnostic test was performed.
- N Engl J Med 2022; 387:356-365
A 49-year-old man with a family history of diabetes was evaluated because of hypoglycemia. Two hours earlier, he had been found on the floor, obtunded and making nonpurposeful movements. A diagnostic test was performed.
- N Engl J Med 2022; 387:261-269
A 34-year-old woman presented with hypercortisolism resulting from a metastatic pancreatic neuroendocrine tumor. Chest CT revealed patchy consolidation with cavitation and tree-in-bud opacities. Management decisions were made.
- N Engl J Med 2022; 387:168-176
A 17-year-old girl was admitted because of prolonged fever and cough. She had an elevated creatinine level and a low hemoglobin level. A diagnostic test was performed.
- N Engl J Med 2022; 386:2508-2516
A 25-year-old man with a history of leukemia and hematopoietic-cell transplantation was evaluated for vision changes. MRI revealed white-matter lesions; PET-CT showed FDG-avid lymphadenopathy. A diagnostic test was performed.
- N Engl J Med 2022; 386:2413-2423
A 29-year-old woman was evaluated for a soft-tissue mass in the pancreatic head, discovered after diarrhea and jaundice occurred. Diagnostic procedures were performed, and management decisions were made.
- N Engl J Med 2022; 386:2316-2326
A 29-year-old woman presented with recurrent bone fractures and hypophosphatemia. The patient had been well until 19 months before admission, when pain in the right foot developed. During the next 19 months, multiple fractures of the metatarsal bones of the right foot occurred. On admission, the blood phosphorus level was...
- N Engl J Med 2022; 386:2222-2231
A 17-year-old boy was admitted to the pediatric ICU with chest pain, syncope, electrocardiographic abnormalities, and elevated creatine kinase and troponin T. He had been well until 5 days earlier, when fever, nausea, diarrhea, muscle aches, and chest pain developed.
- N Engl J Med 2022; 386:2036-2048
A 55-year-old man was evaluated for a mediastinal mass, which was identified during an evaluation for waxing and waning fevers, night sweats, and fatigue. He had mediastinal lymphadenopathy with low FDG uptake, splenomegaly, anasarca, elevated inflammatory marker levels, hypoalbuminemia, anemia, and thrombocytopenia. A diagnosis was made.
- N Engl J Med 2022; 386:1933-1944
A 57-year-old man with polyarteritis nodosa was evaluated for cough and pulmonary opacities. Chest CT revealed multifocal clustered centrilobular nodules and opacities in a tree-in-bud pattern. A galactomannan test was positive. Diagnostic tests were performed.
- N Engl J Med 2022; 386:1834-1844
A 57-year-old man was evaluated in the gastroenterology clinic because of new ascites. Paracentesis yielded milky-appearing ascitic fluid with a triglyceride level of 797 mg per deciliter. CT revealed multiple hypoenhancing liver lesions. There was a history of eosinophilic gastroenteritis and protein-losing enteropathy. A diagnostic test was performed.
- N Engl J Med 2022; 386:1647-1657
A 56-year-old man presented in early autumn with a 1-month history of myalgias and fever. His heart rate was 48 beats per minute. An electrocardiogram showed sinus bradycardia and complete heart block; cardiac imaging showed inflammatory changes in the epicardial fat abutting the noncoronary sinus of the aortic valve. A...
- N Engl J Med 2022; 386:1560-1570
A 41-year-old woman with transient dysarthria and facial droop was evaluated for mitral valve masses. Three weeks earlier, she had heavy vaginal bleeding with crampy abdominal pain, fatigue, and lightheadedness. CT imaging was notable for small chronic cerebral infarcts and uterine fibroids. Diagnostic test results were received, and management decisions...
- N Engl J Med 2022; 386:1453-1461
An 80-year-old woman was admitted with pancytopenia. Five weeks earlier, nausea, vomiting, diarrhea, chills, and fever had developed. CT revealed bilateral pelvic masses; examination of a peripheral-blood smear revealed schistocytes, anisocytosis, and a low platelet count. A diagnostic test was performed, and management decisions were made.
- N Engl J Med 2022; 386:1266-1276
A 78-year-old man was evaluated in the cardiology clinic because of biventricular myocardial wall thickening, mitral regurgitation, and ventricular arrhythmias. In his 20s, hypohidrosis and sports-related exertional dizziness had developed. Echocardiograms obtained over several decades showed thickened ventricles (shown in videos). Diagnostic tests were performed.
- N Engl J Med 2022; 386:1166-1174
A 56-year-old woman was admitted in the spring of 2020 because of fever, myalgias, diarrhea, and a dry cough. Six weeks earlier, she had had contact with a person with SARS-CoV-2 infection. She had mild ground-glass opacities on chest CT, as well as elevated aminotransferase levels and thrombocytopenia. A diagnostic...
- N Engl J Med 2022; 386:1071-1079
A 54-year-old woman was evaluated in the emergency department because of abdominal pain, nausea, and vomiting. Computed tomography of the abdomen and pelvis revealed circumferential jejunal-wall thickening. Medical history was notable for episodic swelling of the arms, hands, and feet. Diagnostic tests were performed, and treatment decisions were made.
Case 7-2022: A 65-Year-Old Woman with Depression, Recurrent Falls, and Inability to Care for HerselfN Engl J Med 2022; 386:977-986
A 65-year-old woman was admitted with depression, recurrent falls, and difficulty caring for herself. She reported weakness on the left side and had a monoplegic gait, but results of strength testing were normal. She was treated for functional neurologic disorder but then had progressive neurologic decline. A diagnostic test was...